Are the cutaneous manifestations during or due to SARS-CoV-2 infection/COVID-19 frequent or not? Revision of possible pathophysiologic mechanisms

• Published in: Inflammation research Vol. 69; no. 8; pp. 745 - 756
• Main Authors: Criado, Paulo Ricardo, Abdalla, Beatrice Martinez Zugaib, de Assis, Isabelle Carvalho, van Blarcum de Graaff Mello, Cristina, Caputo, Gabriela Cacciolari, Vieira, Ingrid Campos
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.08.2020; Springer Nature B.V
• Subjects: ACE2; Allergology; Angiotensin; Angiotensin-Converting Enzyme 2; Arterioles - pathology; Betacoronavirus; Biomedical and Life Sciences; Biomedicine; Capillaries - pathology; Cell activation; Clinical aspects; Coronavirus Infections - complications; Coronavirus Infections - physiopathology; Coronaviruses; COVID-19; Cytokine Release Syndrome - virology; Cytokine storm; Cytokines; Dermatology; Endothelium - pathology; Endothelium - virology; Erythema; Exanthema; Gastrointestinal system; Gastrointestinal tract; Humans; Immune response; Immune System; Immunology; Infections; Innate immunity; Lesions; Lung - pathology; Lung - virology; Macrophages; Medical Subject Headings-MeSH; Monocytes; Neurology; Pandemics; Pathogenesis; Peptidyl-dipeptidase A; Peptidyl-Dipeptidase A - metabolism; Pharmacology/Toxicology; Pneumonia, Viral - complications; Pneumonia, Viral - physiopathology; Purpura; Review; Rheumatology; RNA viruses; SARS-CoV-2; Serine; Serine proteinase; Severe acute respiratory syndrome; Severe acute respiratory syndrome coronavirus 2; Skin diseases; Skin Diseases - complications; Skin Diseases - physiopathology; Skin Diseases - virology; Structural proteins; Treatment Outcome; Viral diseases; Viruses; COVID-19; Innate immunity; SARS-CoV-2; Livedoid vasculitis; Lipoprotein A; Macrophage
• ISSN: 1023-3830; 1420-908X; 1420-908X
• DOI: 10.1007/s00011-020-01370-w

Background SARS-Cov-2 is a single-stranded RNA virus, a Betacoronavirus, composed of 16 non-structural proteins, with specific roles in replication of coronaviruses. The pathogenesis of COVID-19 is not yet fully understood. The virus and host factors interplay among distinct outcomes of infected patients. Methods Using MeSH (Medical Subject Headings) in PubMed, authors searched for articles cotaining information on COVID-19 and the skin. Results The pathophysiology of the disease is multifactorial: association with innate immune response, hypercoagulability state, lung tissue damage, neurological and/or gastrointestinal tract involvement, monocytic/macrophage activation syndrome, culminating in exaggerated cytokine secretion, called “cytokine storm”, which leads to worsening and death. These systemic conditions may be associated with cutaneous lesions, that have polymorphic aspects, where at histopathological level show involvement in different skin changes. These lesions may be associated with multisystemic manifestations that could occur due to angiotensin-converting enzyme 2 receptor and transmembrane serine protease action, allowing the pulmonary infection and possibly skin manifestation. Several reports in literature show cutaneous lesions similar to chilblain, urticarial eruptions, diffuse or disseminated erythema, livedo racemosa, blue toe syndrome, retiform purpura, vesicle trunk, purpuric exanthema or exanthema with clinical aspects of symmetrical drug-related intertriginous and flexural exanthema (SDRIFE) and others. Conclusions This review describes the complexity of Covid-19, pathophysiological and clinical aspects, dermatological finding and other dermatological conditions associated with SARS-CoV-2 infection or COVID-19.